Staged minimally invasive direct coronary artery bypass and percutaneous angioplasty for multivessel coronary artery disease.
OBJECTIVE
Minimally invasive direct coronary artery bypass (MIDCAB) using the left internal mammary artery (IMA) to the left anterior descending (LAD) coronary artery can be performed with low operative risk. MIDCAB can be combined with percutaneous transluminal coronary angioplasty (PTCA) to treat patients with multivessel disease. We report here our experience with staged MIDCAB and PTCA in the management of a selected group of patients.


RESULTS
11 patients (9 males, mean age 64.6+/-8.7 years) with multivessel coronary artery disease received left IMA grafts to the LAD using the MIDCAB approach. There were no postoperative morbidity or mortality. All patients were extubated within 4 h of leaving the operating room with a mean ITU stay of 12.8 h. All patients but two underwent coronary angioplasty during the same hospital admission, 3.8+/-1.3 days after the MIDCAB procedure. Angiography confirmed IMA grafts patency in all patients, and complete revascularisation by PTCA of other coronary arteries was possible in all patients but one. Mean hospital stay was 5.9 days, and all patients remain free of angina at a mean follow-up period of 11.4 months.


CONCLUSIONS
Staged MIDCAB and angioplasty is an experimental approach for the management of selected patients with multi-vessel coronary artery disease. Further experience is needed to clarify patient selection and the long-term outcome of this approach.
Izzat
M B
MB
Division of Cardiothoracic Surgery, The Chinese University of Hong Kong, Shatin. IZZAT@mailserv.CUHK.edu.hk
Yim
A P
AP
Mehta
D
D
Sanderson
J E
JE
Wilde
P
P
Bryan
A J
AJ
Angelini
G D
GD
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D012307:Risk Factors; D016896:Treatment Outcome